Radiofrequency ablation as effective as surgery for small liver tumors

Last Updated: 2006-03-31 11:18:19 -0400 (Reuters Health)

By Karla Gale

NEW YORK (Reuters Health) - Percutaneous radiofrequency (RF) ablation of single small hepatocellular carcinomas is as effective as surgical resection in prolonging survival, Italian investigators report. Ablation also offers a treatment option for patients whose clinical condition precludes surgery.

"In 90% of patients, resection is not the best option," presenter Dr. Riccardo Lencioni told Reuters Health. "Their tumors are resectable but the patients are not medically operable because of their comorbidities, particularly cirrhosis."

Dr. Lencioni and Dr. Laura Crocetti, from the University of Pisa, conducted a case-control study comparing the two treatment modalities in patients with small uninodular hepatocellular carcinomas (HCC) and well-compensated liver cirrhosis. They presented their findings Friday at the Society of Interventional Radiology's annual meeting in Toronto.

According to their meeting abstract, 38 patients underwent hepatic resection and 124 underwent RF ablation. The tumors were no larger than 5 cm in diameter.

RF ablation is not used for larger tumors, Dr. Lencioni noted, because the cancer will probably have metastasized beyond the liver in such cases.

In the surgical resection group, overall survival rates were 89% at 1 year and 65% at 3 years. Corresponding rates were 97% and 72% in the RF ablation group.

"For patients with HCC, a minimally invasive approach with RF ablation, along with precise image targeting and proper follow-up, can achieve a life expectancy equivalent to that of surgical resection," Dr. Lencioni told Reuters Health.

"The key here is that we know in advance who is more likely to develop liver cancer -- those with cirrhosis or chronic hepatitis. The recommendation is that all these patients undergo periodic examination with imaging, either with ultrasound, MRI or CT, to detect the emergence of the tumor at an early stage, before symptoms occur," the radiologist added. "Otherwise, it will be too late" for RF ablation to obliterate the cancer.

The patients also benefit because overnight hospitalization is not usually required, and they can restart their activities within a few days.

Dr. Lencioni pointed out that these patients remain at risk for developing another liver tumor. "Another advantage of RF ablation is that it can be repeated if necessary, but it is difficult to repeat surgical resection."